Research ArticleOriginal Research

Discovery of Breast Cancers Within 1 Year of a Normal Screening Mammogram: How Are They Found?

Patricia A. Carney, Elizabeth Steiner, Martha E. Goodrich, Allen J. Dietrich, Claudia J. Kasales, Julia E. Weiss and Todd MacKenzie
The Annals of Family Medicine November 2006, 4 (6) 512-518; DOI: https://doi.org/10.1370/afm.580

Article Figures & Data

Tables

  • Appendix.

    Characteristics of Tumors in Women With Screen-Detected and Interval Cancers (N = 559)

    Invasive CancersIn Situ Cancers
    Tumor Characteristic*Screen-Detected (n = 345) No. (%)Interval (n = 100) No. (%)PValueScreen-Detected (n = 100) No. (%)Interval (n = 14) No. (%)P Value
    Note: Tumor characteristics were not available for 65 (10%) of the women (36 screen, 29 interval).
    NA = not applicable.
    * Missing: 67 for stage (49 screen, 18 interval); 100 for lymph node status (76 screen, 24 interval); 88 for tumor size (66 screen, 22 interval); and 192 for tumor grade (142 screen, 50 interval).
    Stage
        I or II288 (97)70 (85)<.001NANANA
        III or IV8 (3)12 (15)
    Lymph node status
        Positive71 (26)30 (40).03NANANA
        Negative198 (74)46 (61)
    Tumor size
        ≤10 mm92 (29)15 (18).0240 (62)2 (25).08
        11–20 mm144 (46)37 (44)17 (26)3 (38)
        ≥21 mm78 (25)32 (38)8 (12)3 (38)
    Tumor grade
        1 or 2159 (65)31 (53).0932 (56)2 (40).49
        3 or 487 (35)28 (48)25 (44)3 (60)
  • Table 1.

    Characteristics of Women With Screen-Detected and Interval Cancers

    CharacteristicWomen With Screen-Detected Cancers (n = 481) No. (%)Women With Interval Cancers (n = 143) No. (%)P Value
    GED = graduate equivalent degree; HRT = hormone replacement therapy; CBE = clinical breast examination.
    * Missing: 47 for education (39 screen, 8 interval); 13 for insurance (11 screen, 2 interval); 3 for family history of breast cancer (all screen); 3 for personal history of breast cancer (all screen); 55 for menopausal status and HRT use (41 screen, 14 interval); 24 for breast density (all screen); 85 for time since last mammogram (77 screen, 8 interval), and 296 for time since last CBE (218 screen, 78 interval).
    Age at diagnosis, years.67
        ≤398 (1.7)4 (2.8)
        40–49106 (22.0)35 (24.5)
        50–59140 (29.1)36 (25.2)
        60–69100 (20.8)34 (23.8)
        ≤70127 (26.4)34 (23.8)
    Education*.50
        Less than high school30 (6.8)7 (5.2)
        High school graduate or GED125 (28.3)34 (25.2)
        Some college or technical school128 (29.0)48 (35.6)
        College or postcollege graduate159 (36.0)46 (34.1)
    Insurance*.04
        Yes449 (95.5)140 (99.3)
        No21 (4.5)1 (0.7)
    Family history of breast cancer*.82
        Yes193 (40.4)60 (42.0)
        No279 (58.4)82 (57.3)
        Don’t know6 (1.3)1 (0.7)
    Personal history of breast cancer*<.001
        Yes65 (13.6)43 (30.1)
        No413 (86.4)100 (69.9)
    Menopausal status and current HRT use*.58
        Premenopausal119 (27.1)35 (27.1)
        Postmenopausal, no HRT210 (47.7)56 (43.4)
        Postmenopausal, HRT111 (25.2)38 (29.5)
    Breast density*.48
        Fatty25 (5.5)5 (3.5)
        Scattered density213 (46.6)66 (46.2)
        Heterogeneously dense184 (40.3)56 (39.2)
        Extremely dense35 (7.7)16 (11.2)
    Time since the mammogram before the one associated with the cancer diagnosis*.001
        Never had one22 (5.5)2 (1.5)
        <1 year81 (20.1)35 (25.9)
        1–2 years228 (56.4)89 (65.9)
        >2 years73 (18.1)9 (6.7)
    Time since the CBE before the one associated with the cancer diagnosis*.77
        Never had one4 (1.5)2 (3.1)
        <1 year200 (76.1)48 (73.9)
        1–2 years47 (17.9)13 (20.0)
        >2 years12 (4.6)2 (3.1)
  • Table 2.

    Distribution of Types of Breast Concerns by Patient Age Among 101 Women With Interval Cancers (n = 229 concerns)

    Age, Years*
    Breast Concern†≤39 No. (%)40–49 No. (%)50–59 No. (%)60–69 No. (%)≥70 No. (%)P Value‡
    * Values are no. (%) of concerns of that type; values total across rows.
    † Values in parentheses are numbers of concerns.
    ‡ P value is for the test of independence by each concern across patient age.
    Lump in breast (n = 59)2 (3)21 (36)15 (25)14 (24)7 (12).2
    Skin changes (n = 13)0 (0)3 (23)2 (15)4 (31)4 (31).72
    Family history of breast cancer (n = 61)2 (3)14 (23)14 (23)17 (28)14 (23).45
    Personal history of breast cancer (n = 74)1 (1)21 (28)18 (24)19 (26)15 (19).37
    Other concern (n = 22)1 (5)4 (18)6 (27)4 (18)7 (32).37
  • Table 3.

    Distribution of Breast Cancer Discovery Scenarios by Cluster of Most Common Type of Breast Concern(s) (n = 74 women)

    Cluster of Breast Concerns
    Discovery ScenarioLump Only No. (%)Lump, Pain, Personal History of Breast Cancer No. (%)Lump, Pain, Family History of Breast Cancer No. (%)Lump, Personal & Family History of Breast Cancer No. (%)Personal & Family History of Breast Cancer Only No. (%)P Value*
    Note: Two women were missing a discovery scenario. See text for a description of less frequent concerns in the remaining 23 women.
    CBE = clinical breast examination.
    * P value is for the test of independence for each discovery scenario by type of breast problem.
    Patient initiated health care visit because of a breast concern (n = 45)4 (9)11 (24)6 (13)20 (44)4 (9)<.01
    Clinician found area of concern while conducting routine CBE (n = 11)0 (0)4 (36)3 (27)3 (27)1 (9).15
    Breast cancer was found on next screening mammogram (n = 14)2 (15)1 (7)1 (8)1 (8)9 (64).001
    Other (n = 4)1 (25)0 (0)1 (25)1 (25)1 (25).43

Additional Files

  • The Article in Brief

    Discovery of Breast Cancers Within 1 Year of a Normal Screening Mammogram: How Are They Found?

    By Patricia A. Carney, PhD, and colleagues

    Background There has been little research into how breast cancer is discovered when it is not picked up on a mammogram or when it appears between mammograms. This study looks at how breast cancer is discovered within 1 year of a normal mammogram.

    What This Study Found Of the 143 women in this study, approximately one half decided to visit to the doctor when they had 1 or more breast concerns, especially when they found a lump and had a personal or family history of breast cancer. Seventeen percent of the breast cancers were found by women's primary care doctors, and the rest were picked up on a follow-up mammogram. Most women in the study were cared for by the doctor who referred them for the mammogram that identified the cancer.

    Implications

    • No screening test, including mammograms, picks up all cancers.
    • Women at highest risk for breast cancer should be monitored by their primary care doctor and strongly encouraged to visit the doctor at the first sign of a lump.
    • Women, especially those with a personal or family history of breast cancer, should report breast symptoms to the doctor, even if they have had a recent negative mammogram.
    • An ongoing relationship with a primary care doctor is important in helping to detect breast cancer between mammograms.
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Get Permissions

Jump to section

Subjects